Assisted Suicide – A Libertarian’s Wobble‏

Commuters picking up a Metro this brisk Monday morning will today have been presented with a typically bold headline from the free daily. Company director Simon Binner, 57, suffers from motor neurone disease and plans to die today in Switzerland in a procedure commonly referred to assisted suicide.

Mr Binner announced his intentioned on social media and is said to have spent last night with his wife and family. He planned to spend a final Christmas with his family, but his condition is thought to have accelerated, putting his ability to travel to Switzerland unassisted in doubt.

The news will reopen debate on the law surrounding assisted suicide in the UK, with the British Humanist Society of which Mr Binner is a member calling his decision ‘courageous’, with pro-life groups suggesting he was ‘blinded’ by his condition and it’s effects on his family.

As a libertarian I’ve long supported the cause of assisted suicide, for in an age when our rights and freedoms are daily chipped away at we must, surely, at least retain the right to decide how and when we expire. And it sometimes seems that those who keep the terminally ill alive and in pain do so partly through love and a respect for the sanctity of life, but partly because they don’t want the guilt that would inevitably come with ending a loved ones life, even if done so at the sufferers behest.

Advocates of assisted dying point to the benefits of living wills and the rights of patients to clearly refuse extraordinary end of life care, removing often excruciating dilemmas placed on loved ones. Choosing to end ones own life also permits that person to pass away not only painlessly but also with dignity, surrounded by friends and family able to remember them while they were still cognitive, often at home without the sterile and impersonal apparatus of late life health care.

The arguments for seem reasonable enough, but what about the concerns? The first and broadest is the slippery slope argument. Once you let people die to avoid pain and distress to loved ones as well ceasing to be a burden, how long will it be until that becomes expected? For when people can chose to end their lives early it’s only a matter of time before there exists an unwritten social pressure on the sick and elderly to ‘do the decent thing’. We’ll arrive at a place where wanting to live with certain illnesses will be seen as selfish and inconsiderate, precisely the opposite of the genuine compassionate motivations of assisted dying advocates.

In a society as obsessed with the costs of health care and the principle of utility, the dangers of the slippery slope are far from fantasy.

Assisted suicide could end up a half-way house, a stop on the way to other forms of direct euthanasia, for example, for incompetent patients by advance directive or suicide in the elderly. So, too, is voluntary euthanasia a half-way house to involuntary and nonvoluntary euthanasia. If terminating life is a benefit, the reasoning may go, why should euthanasia be limited only to those who can give consent? Why need we ask for consent?

The option for euthanasia has side effects too. For example in the Netherlands where euthanasia is legal, there exists only the most meager of palliative end of life care. Hospices provide crucial practical and moral support to patients and their families but these would surely be slowly starved of resources when seen as unnecessary.

It must also be recognised that assisted suicide and euthanasia will be practiced through the prism of social inequality and prejudice that characterises the delivery of services in all segments of society, including health care. Those who will be most vulnerable to abuse, error, or indifference are the poor, minorities, and those who are least educated and least empowered. This risk does not reflect a judgment that physicians are more prejudiced or influenced by race and class than the rest of society – only that they are not exempt from the prejudices manifest in other areas of our collective life.

While our society aspires to eradicate discrimination and the most punishing effects of poverty in employment practices, housing, education, and law enforcement, we consistently fall short of our goals. The costs of this failure with assisted suicide and euthanasia would be extreme. Nor is there any reason to believe that the practices, whatever safeguards are erected, will be unaffected by the broader social and medical context in which they will be operating. This assumption is naive and unsupportable.

I still belive the smallest minority is the individual and that the rights of individual trump those of some arbitrary ‘collective’. However assisted dying, like so much else, demonstrate the limits of ideology.